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Nat Commun. 2018 Jan 8;9(1):88. doi: 10.1038/s41467-017-02577-y.

Multi-day rhythms modulate seizure risk in epilepsy.

Author information

1
Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, CA, 94143, USA. maxime.baud.neuro@gmail.com.
2
Department of Neurology, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland. maxime.baud.neuro@gmail.com.
3
Wyss Center for Bio and Neuroengineering, 1202, Geneva, Switzerland. maxime.baud.neuro@gmail.com.
4
Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, University of Bern, 3010, Bern, Switzerland. maxime.baud.neuro@gmail.com.
5
Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, CA, 94143, USA.
6
NeuroPace, Inc., 455N. Bernardo Ave, Mountain View, CA, 94043, USA.
7
Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, DE, 19716, USA.
8
Department of Neurology, California Pacific Medical Center, San Francisco, CA, 94115, USA.
9
Department of Neurological Surgery and Weill Institute for Neurosciences, University of California, San Francisco, CA, 94143, USA.

Abstract

Epilepsy is defined by the seemingly random occurrence of spontaneous seizures. The ability to anticipate seizures would enable preventative treatment strategies. A central but unresolved question concerns the relationship of seizure timing to fluctuating rates of interictal epileptiform discharges (here termed interictal epileptiform activity, IEA), a marker of brain irritability observed between seizures by electroencephalography (EEG). Here, in 37 subjects with an implanted brain stimulation device that detects IEA and seizures over years, we find that IEA oscillates with circadian and subject-specific multidien (multi-day) periods. Multidien periodicities, most commonly 20-30 days in duration, are robust and relatively stable for up to 10 years in men and women. We show that seizures occur preferentially during the rising phase of multidien IEA rhythms. Combining phase information from circadian and multidien IEA rhythms provides a novel biomarker for determining relative seizure risk with a large effect size in most subjects.

PMID:
29311566
PMCID:
PMC5758806
DOI:
10.1038/s41467-017-02577-y
[Indexed for MEDLINE]
Free PMC Article

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